Claim Form

Click here to download a PDF copy of the Claim Form. Standard claims processing time is five to seven business days from the day we receive your claim. If you are not enrolled in direct deposit, remember to allow adequate time to receive your paper check reimbursements in the mail.

Get your money back faster by submitting claims and supporting documentation online after logging in or by using our mobile app, HRAgo®.

Read our How to File a Claim handout to learn more. To get a copy, log in and click Resources, or request a copy from our customer care center.